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The Global Initiative for Asthma (GINA) was established in 1993 by the World Health Organization and the US National Heart Lung and Blood Institute to improve asthma awareness, prevention and management worldwide. GINA develops and publishes evidence-based, annually updated resources for clinicians. GINA guidance is adopted by national asthma guidelines in many countries, adapted to fit local healthcare systems, practices, and resource availability. GINA is independent of industry, funded by the sale and licensing of its materials. This review summarizes key practical guidance for primary care from the 2022 GINA strategy report. It provides guidance on confirming the diagnosis of asthma using spirometry or peak expiratory flow. GINA recommends that all adults, adolescents and most children with asthma should receive inhaled corticosteroid (ICS)-containing therapy to reduce the risk of severe exacerbations, either taken regularly, or (for adults and adolescents with “mild” asthma) as combination ICS–formoterol taken as needed for symptom relief. For patients with moderate–severe asthma, the preferred regimen is maintenance-and-reliever therapy (MART) with ICS–formoterol. Asthma treatment is not “one size fits all”; GINA recommends individualized assessment, adjustment, and review of treatment. As many patients with difficult-to-treat or severe asthma are not referred early for specialist review, we provide updated guidance for primary care on diagnosis, further investigation, optimization and treatment of severe asthma across secondary and tertiary care. While the GINA strategy has global relevance, we recognize that there are special considerations for its adoption in low- and middle-income countries, particularly the current poor access to inhaled medications.

Study Objectives: The purpose of this study was to determine whether a wearable sleep-tracker improves perceived sleep quality in healthy participants and to test whether wearables reliably measure sleep quantity and quality compared with polysomnography. Methods: This study included a single-center randomized crossover trial of community-based participants without medical conditions or sleep disorders. A wearable device (WHOOP, Inc.) was used that provided feedback regarding sleep information to the participant for 1 week and maintained sleep logs versus 1 week of maintained sleep logs alone. Self-reported daily sleep behaviors were documented in sleep logs. Polysomnography was performed on 1 night when wearing the wearable. The Patient-Reported Outcomes Measurement Information System sleep disturbance sleep scale was measured at baseline, day 7 and day 14 of study participation. Results: In 32 participants (21 women; 23.8 ± 5 years), wearables improved nighttime sleep quality (Patient-Reported Outcomes Measurement Information System sleep disturbance:B = −1.69; 95% confidence interval, −3.11 to −0.27; P =.021) after adjusting for age, sex, baseline, and order effect. There was a small increase in self-reported daytime naps when wearing the device (B = 3.2; SE, 1.4; P =.023), but total daily sleep remained unchanged ( P =.43). The wearable had low bias (13.8 minutes) and precision (17.8 minutes) errors for measuring sleep duration and measured dream sleep and slow wave sleep accurately (intraclass coefficient, 0.74 ± 0.28 and 0.85 ± 0.15, respectively). Bias and precision error for heart rate (bias, −0.17%; precision, 1.5%) and respiratory rate (bias, 1.8%; precision, 6.7%) were very low compared with that measured by electrocardiogram and inductance plethysmography during polysomnography. Conclusions: In healthy people, wearables can improve sleep quality and accurately measure sleep and cardiorespiratory variables. Clinical Trial Registration: Registry: ClinicalTrials.gov ; Name: Assessment of Sleep by WHOOP in Ambulatory Subjects; Identifier:NCT03692195. Citation: Berryhill S, Morton CJ, Dean A, et al. Effect of wearables on sleep in health individuals: A randomized crossover trial and validation study. J Clin Sleep Med . 2020;16(5):775–783.

Ambulatory oxygen therapy is prescribed for patients with chronic lung diseases who experience exertional hypoxemia. However, available devices may not adequately meet user requirements, and their performance characteristics are heterogeneous. This study aims to identify devices available for delivery of ambulatory oxygen therapy, the technologies that they use to generate oxygen, the performance characteristics of each device, and the development status. We used medical and engineering databases to identify peer-reviewed papers (eg, MEDLINE, IEEE). Gray literature was used to identify additional descriptions of ambulatory oxygen devices in military medicine, space exploration, or patents. The last search was conducted in September 2025. Documents that described a device that can deliver oxygen in an ambulatory context (defined as weighing less than 10 kg) and were written in English were included. Search results were screened for inclusion by 2 independent reviewers. Data were synthesized by descriptively mapping the performance of each product, the technology used, and the development status of emerging technologies. From 9702 records identified, a total of 166 met eligibility criteria (106 scientific publications and 60 gray literature). We identified 33 portable oxygen concentrators (POCs; 29 commercially available), 10 oxygen cylinders, and 6 portable liquid oxygen (LOX) devices. The POC products showed a trade-off between portability and oxygen delivery capacity (maximum flow rate ranging from 2.0 to 6.0 L/min; device weight ranging from 1.0 to 9.1 kg). Pressure swing adsorption with zeolite was the most common oxygen generation technology in POCs on the market. The mean maximum continuous operating time of POCs was 3.8 hours. Two prototype POCs (maximum flow rate of 4-6 L/min and device weight of 8-9 kg) were developed for space exploration using modified adsorbents. LOX devices were the lightest and had the longest continuous operating time. Innovations in delivery included the downsizing of a POC by using nanozeolite as an adsorbent and pulse oximeter oxygen saturation (SpO )-targeted automatic titration of oxygen delivery based on the user's SpO . This scoping review is the first study to integrate medical, engineering, and gray literature on ambulatory oxygen devices and their development. Although prior literature has narratively explained the products and technologies, no previous research has systematically investigated them. This review showed that POCs available to consumers may not meet the needs of patients in terms of flow rate, portability, and operating time. LOX devices offered superior performance but are limited by high costs. Limitations of this review include the difficulty of comparing product performance across oxygen delivery settings and that the records were largely obtained from English-language sources. Innovation in ambulatory oxygen technology has been limited over the past decade, highlighting urgent need for research and development of new lightweight devices with higher oxygen delivery. OSF Registries 10.17605/OSF.IO/QS7FX; https://osf.io/qs7fx.

The purpose of this study was to explore the association between perceived social support and COPD outcomes and to determine whether the associations are mediated by depressive symptoms. Subjects with COPD who were enrolled as part of SPIROMICS were included in this analysis. Questionnaires relating to quality of life, symptom burden, and functional status were administered at annual clinic visits for over a 3 year period. In both cross-sectional and longitudinal analyses, we examined the association of social support as measured by the FACIT-F with COPD outcomes. Cross sectional analyses used multivariable linear or logistic regression, adjusting for covariates. For longitudinal analyses, generalized linear mixed models with random intercepts were used. Models were adjusted with and without depressive symptoms and mediation analyses performed. Of the 1831 subjects with COPD, 1779 completed the FACIT- F questionnaire. In adjusted cross-sectional analysis without depressive symptoms, higher perceived social support was associated with better quality of life, well-being, 6 minute walk distance, and less dyspnea. When also adjusting for depressive symptoms, all associations between social support and COPD outcomes were attenuated and no longer statistically significant. Mediation analysis suggested that depressive symptoms explained the majority (> = 85%) of the association between social support and measured COPD outcomes. Results of the longitudinal analysis were consistent with the cross-sectional analyses. There was no association between social support and odds of exacerbations. Higher social support was associated with better COPD outcomes across several measures of morbidity including quality of life, respiratory symptoms, and functional status. In addition, these associations were largely attenuated when accounting for depressive symptoms suggesting that the beneficial association of social support with COPD outcomes may be largely mediated by the association between social support and depression. SPIROMICS was approved by Institutional Review Boards at each center and all participants provided written informed consent (clinicaltrials.gov: NCT01969344).

Design expertise can improve delivery of care

Systematic reviews consist of a set of activities for each PICO question, including prospectively defining study eligibility criteria and literature search strategies; a process by which study titles, abstracts, and full-text articles are reviewed; assessments of the quality of each included study; a structured presentation of the study designs and results of studies relevant to each PICO question; an evaluation for the potential of publication bias; and qualitative or quantitative (metaanalyses) synthesis of results across studies for each outcome within each PICO question. What is clear is that the strength of recommendations and associated quality of evidence are critical aspects of guidelines which can influence policies affecting clinical practice (e.g., performance measures and reimbursement by payers) (i2, i3). [...]while Schoenberg and colleagues deserve praise for evaluating an alternate approach to developing ATS-sponsored guidelines, further studies using CORE are needed. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America clinical practice guidelines: treatment of drugsusceptible tuberculosis. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children.

Abstract Rationale The patterns and outcomes of noninvasive, positive-pressure ventilation (NIPPV) use in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (COPD) nationwide are unknown. Objectives To determine the prevalence and trends of noninvasive ventilation for acute COPD. Methods We used data from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample to assess the pattern and outcomes of NIPPV use for acute exacerbations of COPD from 1998 to 2008. Measurements and Main Results An estimated 7,511,267 admissions for acute exacerbations occurred from 1998 to 2008. There was a 462% increase in NIPPV use (from 1.0 to 4.5% of all admissions) and a 42% decline in invasive mechanical ventilation (IMV) use (from 6.0 to 3.5% of all admissions) during these years. This was accompanied by an increase in the size of a small cohort of patients requiring transition from NIPPV to IMV. In-hospital mortality in this group appeared to be worsening over time. By 2008, these patients had a high mortality rate (29.3%), which represented 61% higher odds of death compared with patients directly placed on IMV (95% confidence interval, 24–109%) and 677% greater odds of death compared with patients treated with NIPPV alone (95% confidence interval, 475–948%). With the exception of patients transitioned from NIPPV to IMV, in-hospital outcomes were favorable and improved steadily year by year. Conclusions The use of NIPPV has increased significantly over time among patients hospitalized for acute exacerbations of COPD, whereas the need for intubation and in-hospital mortality has declined. However, the rising mortality rate in a small but expanding group of patients requiring invasive mechanical ventilation after treatment with noninvasive ventilation needs further investigation.

Abstract Two landmark trials conducted more than 35 years ago provided scientific evidence that, under very specific circumstances, long-term oxygen therapy (LTOT) may prolong life. These two trials enrolled 290 patients with chronic obstructive pulmonary disease and severe daytime hypoxemia documented by direct arterial blood gas measurement. From that time, LTOT became a standard of care, and the indications for oxygen therapy expanded to include nocturnal oxygen therapy for isolated nocturnal oxygen desaturation, ambulatory oxygen to correct exercise-induced desaturation, and short-burst oxygen to relieve dyspnea. In most cases, the rationale for broadening the indications for oxygen therapy is that, if hypoxemia exists, correcting it by increasing the FiO2 should help. However, with the exception of LTOT in severely hypoxemic patients with chronic obstructive pulmonary disease, randomized controlled trials of oxygen therapy have failed to demonstrate clinically significant benefits. Also, adherence to LTOT is usually suboptimal. Important areas for future research include improving understanding of the mechanisms of action of supplemental oxygen, the clinical and biochemical predictors of responsiveness to LTOT, the methods for measuring and enhancing adherence to LTOT, and the cost-effectiveness of oxygen therapy. A standardization of terminology to describe the use of supplemental oxygen at home is provided.

Abstract Rationale Relationships between chronic health conditions and acute infections remain poorly understood. Preclinical studies suggest crosstalk between nervous and immune systems. Objectives To determine bidirectional relationships between cognition and pneumonia. Methods We conducted longitudinal analyses of a population-based cohort over 10 years. We determined whether changes in cognition increase risk of pneumonia hospitalization by trajectory analyses and joint modeling. We then determined whether pneumonia hospitalization increased risk of subsequent dementia using a Cox model with pneumonia as a time-varying covariate. Measurements and Main Results Of the 5,888 participants, 639 (10.9%) were hospitalized with pneumonia at least once. Most participants had normal cognition before pneumonia. Three cognition trajectories were identified: no, minimal, and severe rapid decline. A greater proportion of participants hospitalized with pneumonia were on trajectories of minimal or severe decline before occurrence of pneumonia compared with those never hospitalized with pneumonia (proportion with no, minimal, and severe decline were 67.1%, 22.8%, and 10.0% vs. 76.0%, 19.3%, and 4.6% for participants with and without pneumonia, respectively; P < 0.001). Small subclinical changes in cognition increased risk of pneumonia, even in those with normal cognition and physical function before pneumonia (β = −0.02; P < 0.001). Participants with pneumonia were subsequently at an increased risk of dementia (hazard ratio, 2.24 [95% confidence interval, 1.62–3.11]; P = 0.01). Associations were independent of demographics, health behaviors, other chronic conditions, and physical function. Bidirectional relationship did not vary based on severity of disease, and similar associations were noted for those with severe sepsis and other infections. Conclusions A bidirectional relationship exists between pneumonia and cognition and may explain how a single episode of infection in well-appearing older individuals accelerates decline in chronic health conditions and loss of functional independence.